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Updated: Nov 4, 2025
Murine Renal Transplantation Procedure
Published on: July 10, 2009
Cryptococcus neoformans meningitis in kidney transplant recipients: A diagnostic and therapeutic challenge
Julien Gras1,2, Yanis Tamzali1, Blandine Denis1
1Infectious Diseases Department, APHP, Saint-Louis Hospital, Paris, France.
Abstract:
Cryptococcosis is the third most common invasive fungal infection in solid organ transplant recipients. We describe three cases of neuro-meningeal cryptococcosis occurring among kidney transplant (KT) patients, and discuss the diagnostic and therapeutic challenges in this context. Median time from KT to infection was 6 months [range: 3-9]. The most common clinical manifestations at diagnosis were fever (2/3), headache (2/3), and confusion (2/3); none had extra-neurological involvement. CrAg was positive in all cases at diagnosis both in serum and cerebrospinal fluid (CSF). For two patients, analysis of previous samples showed that CrAg was detected in plasma up to 4 weeks before diagnosis. All patients received induction treatment with liposomal amphotericin-B (L-AmB) and flucytosine for a median duration of 10 days [range: 7-14], followed by fluconazole maintenance therapy. Acute kidney injury secondary to L-AmB therapy was observed in only one case, but all patients had a tacrolimus overdose following initiation of maintenance therapy due to drug-drug interactions between fluconazole and tacrolimus. Among KTR, early detection of Cryptococcus meningitis using serum CrAg is possible. Close monitoring of renal function during treatment is essential due to the nephrotoxicity of L-AmB, but also drug-drug interactions between fluconazole and calcineurin inhibitors.
Insights
Early detection of Cryptococcus meningitis in kidney transplant recipients is possible using serum CrAg. Close monitoring for kidney injury and drug interactions is crucial during treatment.
Area of Science:
- Mycology
- Infectious Diseases
- Nephrology
Background:
- Cryptococcosis is a significant invasive fungal infection in solid organ transplant recipients.
- Neuro-meningeal cryptococcosis presents diagnostic and therapeutic challenges in kidney transplant patients.
Purpose of the Study:
- To describe three cases of neuro-meningeal cryptococcosis in kidney transplant recipients.
- To discuss diagnostic and therapeutic challenges in this patient population.
Main Methods:
- Case series describing three kidney transplant recipients with neuro-meningeal cryptococcosis.
- Analysis of clinical manifestations, diagnostic methods (serum and CSF CrAg), and treatment regimens.
- Monitoring for adverse events, including acute kidney injury and drug-drug interactions.
Main Results:
- Median time from kidney transplant to infection was 6 months.
- Common symptoms included fever, headache, and confusion; no extra-neurological involvement was noted.
- Serum and CSF CrAg were positive in all cases; serum CrAg was detectable up to 4 weeks prior to diagnosis in two patients.
- Induction therapy with liposomal amphotericin-B and flucytosine followed by fluconazole maintenance was administered.
- One patient developed acute kidney injury; all experienced tacrolimus overdose due to fluconazole interaction.
Conclusions:
- Serum CrAg enables early detection of Cryptococcus meningitis in kidney transplant recipients.
- Close renal function monitoring is essential due to L-AmB nephrotoxicity and fluconazole-calcineurin inhibitor interactions.
- Managing drug-drug interactions is critical for optimizing treatment outcomes.
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